Transcript CCRhlthtechnetFeb04

Status of the CCR:
Continuity of Care Record
Claudia Tessier, CAE, RHIA
Co-Chair, ASTM E31 Workgroup on CCR
Executive Director, MoHCA
Health Tech Net
February 20, 2004
What Is the CCR?
 Core data set of the most relevant and timely
facts about a patient’s healthcare.
 Organized and transportable.
 Prepared by a practitioner at the conclusion
of a healthcare encounter.
 To enable the next practitioner to readily
access such information.
 May be prepared, displayed, and transmitted
on paper or electronically.
Development of the CCR
 Unique standards development effort
 Consortium of sponsoring organizations
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ASTM International
Massachusetts Medical Society
HIMSS
AAFP
AAP
Additional sponsoring organizations pending
CCR Will Benefit Healthcare Process
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Foster and improve continuity of care
Enhance patient safety
Reduce medical errors
Reduce costs
Enhance efficiency of health information
exchange
 Assure at least a minimum standard of health
information transportability when patient is
referred to, transferred to, or otherwise seen
by another provider
Why Is the CCR Needed?
 CCR addresses the lack of appropriate,
succinct, and up-to-date patient health
information for practitioners at a new point of
care.
 CCR data is essential to good patient care
and serves as a necessary bridge to a
different environment, often with new
practitioners who know little about the patient.
How Does the CCR Help Practitioners?
 With the CCR the next healthcare practitioner can
 Be informed about a patient’s allergies, medications,
current and recent past diagnoses, most recent
healthcare assessments and services, advance
directives, and the recommendations of practitioners
who last treated the patient.
 More quickly and easily verify patient demographics
and insurance status.
 Minimize the effort to update patient’s most essential
and relevant information in an EHR.
 Reduce costs associated with the patient’s care.
What’s in the CCR?
 CCR identifying information
 Patient identifying information
 Patient insurance/financial information
 Advance directives
 Patient’s health status
 Care documentation
 Care plan recommendation
 Practitioners
CCR Standard Specification
 CCR scope
 Referenced documents
 Terminology (definitions)
 Significance and Use
 Specifications
 Conceptual Model
 Sections of CCR
 Annex A: Spreadsheet of core elements
 Annex B: XML schema
 Annex C: Example report
Conceptual Model
Annex A of Standard Specification
 Detailed list of the CCR data groups.
 Fields
 Associated definitions, comments, examples
 Specification of whether field is required or optional
 Required XML when preparing CCR in a structured
electronic format
 Notes
 Date groups can be repeated as necessary
 Wherever a code is used (e.g., Diagnosis: 461.9), the
type and version of the system (e.g., ICD-9-CM) used
to assign the code must be included.
 Links where appropriate to
Conditions/Diagnoses/Problems and Care
Recommendations.
A Sample Data Element
 Social History and Health Risk Factors
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Definition: This Data Group provides
information on social and personal factors that
may impact the patient's health.
Comments/Examples: Smoking/Tobacco Use,
Diet, Exercise, ETOH Use, Living Situation,
Travel History, and Environmental or
Occupational Exposures.
Required or Optional: Optional
XML: <RISK.FACTOR><ATTRIBUTE>
When Is the CCR Used?
 Referral or transfer: Referring practitioner transmits
the CCR to receiving practitioner and new care
setting where patient is being sent so that it arrives
before or with patient.
 Discharge without a referral or transfer: CCR is
provided to patient for future use, including visits to
urgent care or emergency department, and to
whomever patient designates as primary care
practitioner responsible for followup care, if needed.
 Personal health record: Patient keeps copies of
his/her CCRs and supplements them, e.g., with
alternative medicine information and other PHI.
 Other: Also useful to researchers and others not
directly involved in patient’s treatment.
For Maximum Utility: XML
 XML structured electronic format makes CCR
 Interchangeable
 Allows flexibility to prepare, transmit, and view
CCR in multiple ways
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In a browser
HL7 CDA-compliant document
Secure email
Within any XML-enabled word processing
document
Allows display of fields in multiple formats
Allows interchange of CCR between otherwise
incompatible EHR systems
The EHR and the CCR
 Using the XML specified in this standard,
EHR systems will be able
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to import and export all CCR data
to enable automated healthcare information
transmission with minimal workflow disruption
for practitioners.
 The CCR will provide additional content and
support for the EHR through extensions.
Extensions for Additional Content
 Enterprise and institution-specific
 Acute care, long-term care, home care, etc.
 Clinical specialty-specific
 Pediatrics, Nursing, etc.
 Disease management
 Disease-specific information, performance measures,
guidelines, etc.
 May be used by health plans, pharmas, patient advocacy
groups, others promoting best practices
 Payers
 Additional financial information and care documentation
 Patient-entered Personal Health Record
 Complimentary and alternative medicine
 Private or sensitive health information
 Expanded family history
Other CCR-related Activities
 HIMSS/HL7 demonstration at HIMSS
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Connectathon
CCR representatives assisting HL7 with
preparation
 TEPR CCR demonstration
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USB drive with CCR loaded on it
Will require secure access
Vendors will demonstrate ability to upload,
read, and transmit CCR
Other CCR-related Activities
 Potential for demonstration and implementation
projects
 Possible funding through private and public
organizations, e.g., AHRQ grants
 Demonstration of utilization of CCR in movement
of patients between practitioners and care-settings
 Long-term care to/from acute care settings
 Primary care to/from specialist
 Acute care to/from home care
 Several similar efforts internationally, e.g., Finland,
Denmark, England, The Netherlands, Germany,
Spain
Development of CCR and Extensions
 Meetings of stakeholders
 Circulation and website postings of evolving
standard
 Balloting
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Requires ASTM membership
Nonmember database also developed for
updates, meeting notices, opportunities for
input
CCR Timeline for 2004-2005
 CCR balloting in February, results in March
 April meeting agenda
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Resolve negatives, if any
Expand awareness of CCR
Develop implementation guide
Develop extensions
Do demonstration projects
 Ballot standards addressing extensions and
implementation guide
 Maintain/update standards
Thank you!
 For more information on the CCR
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Claudia Tessier, RHIA
202-659-2699
[email protected]